We discuss 3 cases of incomplete scaffold expansion leading to early in-scaffold thrombosis. The first case is that of a 64-year-old man who received a bioresorbable coronary scaffold (12 atm, 3.0 × 18 mm) in the proximal left anterior descending artery (Figure 1A). Ticagrelor was administered. 15 min later, the patient underwent emergency angiography for angina and anterior ST-segment elevation. Optical coherence tomography (OCT) showed an in-scaffold, red blood cell–rich thrombus, a thin-cap calcific plaque, and mild scaffold underexpansion (Figures 1B and 1C, Online Video 1). The second case is that of a 53-year-old woman who received a scaffold (3.0 × 18 mm, 12 ATM) in the right coronary artery (Figures 2A and 2B). Ticagrelor was prescribed. Four days later, she presented with inferior ST-segment elevation. The vessel was completely occluded by intravascular thrombosis (Figures 2C and 2D). The third case is that of a 53-year-old diabetic woman who received a scaffold (2.5 × 18 mm, 14 ATM) in the proximal left anterior descending artery (Figure 3A). Ticagrelor was prescribed. Six days later, she returned with anterior ST-segment elevation and cardiogenic shock (Figure 3B). OCT demonstrated in-scaffold thrombosis, a severely calcified vessel, and incomplete scaffold expansion (Figures 3C and 3D, Online Video 2). OCT evidence of underexpansion emphasizes the importance of intracoronary imaging and effective, high-pressure postdilation at the time of implantation.

Appendix

For supplemental videos, please see the online version of this article.

Footnotes

Drs. Gori and Münzel have received Speakers’ Bureau honoraria from Abbott Vascular and St. Jude Medical. Dr. Schulz has reported that he has no relationships relevant to the contents of this paper to disclose.